Domestic and Sexual Violence __________________________________________________________________
Healthcare professionals in all settings should remain aware of the potential for abuse and keep a watchful eye on this particularly vulnerable group. Rapport is key in order to gain the trust of the victim. All elder abuse screening tools require trust and rapport to be effective [70].
stigma experienced can exacerbate the domestic violence, with victims further isolating themselves and tolerating the abuse [76]. Healthcare professionals should strive to be sensitive and supportive when working with homosexual patients. Twenty-six percent of transgender and gender non-conforming individuals have been physically assaulted and 4% have been sexually assaulted [72]. In a study of transgender women, 78.1% experienced gender-related psychological abuse and 50% expe- rienced gender-related physical abuse [77]. The Transgender Day of Remembrance is held in November of each year to memorialize those who were killed due to anti-transgender hatred or prejudice. In total, more than 375 murders world- wide were documented in 2021 alone, the most of any year on record; the actual count is likely much higher. In 2024, at least 32 homicides against transgender persons were committed in the United States [78]. The National Center for Transgender Equality recommends that ending violence against transgender people should be a public health priority, because of the direct and indirect negative effect violence has on both victims and on the healthcare system that treats them. INDIVIDUALS EXPERIENCING HOMELESSNESS The intersection of homelessness and domestic and/or sexual violence is bidirectional and complex. Studies indicate up to 92% of homeless women have experienced severe physical or sexual abuse at some point in their lives, and as many as 57% of all homeless women report domestic violence as the immediate cause of their homelessness [79; 80; 81]. Furthermore, victims of stranger-perpetrated violence are more likely to have been homeless on multiple occasions [82]. Homeless domestic violence victims face unique barriers to accessing help, including affordable housing, as a result of actions of their perpetrator. They may face housing discrimina- tion, lack stable employment histories, and have poor credit as a result of their abuse histories [79]. In addition, a study pub- lished by the National Online Resource Center on Violence Against Women found that homeless women are “particularly vulnerable to multiple forms of interpersonal victimization, including sexual and physical assault at the hands of strangers, acquaintances, pimps, sex traffickers, and intimate partners on the street, in shelters, or in precarious housing situations” [80]. The sexual assault experiences of homeless women are more likely to be violent and include multiple sexual acts than women with housing [83]. Because homeless victims of violence face specific barriers to seeking and receiving services, interventions and assistance should be targeted to their specific needs. Homeless young adults who are sexually assaulted, for example, are reluctant to obtain a post-assault exam in part because they fear of get- ting involved in the legal system [84]. It is also important to remember that additional marginalizing factors (e.g., gender/ sexual minority status, geographic isolation) compound the problems experienced by survivors.
The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older or vulnerable adults. (https://jamanetwork.com/journals/jama/
fullarticle/2708121. Last accessed May 29, 2025.) Level of Evidence : I (Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.)
LESBIAN, GAY, BISEXUAL, AND TRANSGENDER VICTIMS Domestic violence exists in LGBT+ communities, and the rates are thought to mirror those of heterosexual women—approxi- mately 25% [71]. However, women living with female intimate partners experience less IPV than women living with men. Conversely, men living with male intimate partners experience more IPV than do men who live with female intimate partners. In addition, 77% of IPV homicide victims reported in 2015 were transgender women or cisgender men [72]. This supports other statistics indicating that IPV is perpetrated primarily by men. A form of abuse specific to the gay community is for an abuser to threaten or to proceed with “outing” a partner to others [71]. Transgender individuals appear to be at particular risk for violence. According to a large national report, transgender victims of IPV were 1.9 times more likely to experience physical violence and 3.9 times more likely to experience discrimina- tion than other members of the LGBT+ community [72]. In a study using 2011–2013 National College Health Assessment data involving more than 88,000 college students, transgender and bisexual students reported the highest levels of intimate partner violence [73]. These increased rates may be due to experiences with marginalization; the use of power and abuse are expressions of control and agency [73]. Because of the stigma of being LGBT+, victims may be reticent to report abuse and afraid that their sexual orientation or bio- logic sex will be revealed. In one study, the three major barriers to seeking help were a limited understanding of the problem of LGBT+ IPV, stigma, and systemic inequities [74]. Many in this community feel that support services (e.g., shelters, sup- port groups, crisis hotlines) are not available to them due to homophobia of the service providers. Providers’ responses can be dismissive to LGBT+ domestic violence victims [75]. The
9
MDCT2026
Powered by FlippingBook